1669457859 NPI number — GREENVILLE PROAXIS THERAPY, LLC

Table of content: (NPI 1669457859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669457859 NPI number — GREENVILLE PROAXIS THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENVILLE PROAXIS THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669457859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 BUTTERFIELD RD STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-2223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 N MAIN ST
Provider Second Line Business Practice Location Address:
STE 99
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29601-2796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-528-5728
Provider Business Practice Location Address Fax Number:
864-528-5729
Provider Enumeration Date:
12/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
WADE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VP CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
630-296-2222

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DD4407 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP4143 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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